| NPI | 1770503070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD 0110001562) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: VA 0110001562) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-03-28 |